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Should we consider a boycott of Israeli academic institutions? No

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In your ‘Correction’, published on 19th May 2010 (BMJ
2010;340:c2680),
Professor Michael Baum has conceded that Dr Derek Summerfield is sincere
in
his belief that the Israeli Medical Association (IMA) is complicit in
torture, even
though Professor Baum is equally convinced that the Association is not.
However, the IMA has still failed to answer pressing relevant questions
about
Summerfield’s charge.

In October 2009, one of us outlined in the BMJ (BMJ 2009;339:b4078)
the
failure of the IMA adequately to respond to a complaint submitted by
Physicians for Human Rights-Israel (PHR-I) and the Public Committee
Against
Torture in Israel (PCATI). This complaint contained detailed testimonies
of
several torture victims who had been attended by named Israeli medical
personnel, and described in a Report, ‘Ticking Bombs,’ published in May
2007
(http://www.stoptorture.org.il/files/140%5B1%5D.pdf). Following a demand
that the IMA respond to this 2007 Report, the Chairman of the
Association’s
Ethics Board replied to PHR-I and PCATI in March 2009, reporting that he
had
spoken to ‘most of those listed,’ each of whom denied any such
involvement.
In their May 2009 reply, the Directors of PHR-I and PCATI suggested that,
since the IMA is an Association responsible for doctors' ethical conduct,
the
investigation should have included detailed file review, documentation of
examinations and treatment, and conversations with doctors working in the
civil hospitals where the prisoners had been treated. They also called for
the
IMA to act to instill the rules of medical ethics among physicians working
in
public hospitals and detention facilities. They also made clear to the IMA
if the
Association decided that it is not within its capacity to take these
steps, it
must direct the cases raised in the report to the Ministry of Health or
the
Ministry of Justice for further inquiry and action. The Israeli Medical
Association has not responded to PHR-I, PCATI, the BMJ or the author of
the
article.

In the 3 years since PCATI's ‘Ticking Bombs’ report it has received
additional
complaints of torture of Palestinian prisoners in detention in Israel, and
these
include further allegations of medical complicity in torture. The IMA has
been
informed of a specific case in which doctors in an Emergency Room not only

failed to report injuries that a Palestinian prisoner allegedly sustained
while he
was undergoing questioning by the General Security Service, but also
returned
the prisoner to detention 2 hours later (http://www.haaretz.com/print-
edition/news/health-min-israel-medical-association-probing-whether-
physicians-failed-to-report-torture-of-palestinian-detainee-1.266495).
The IMA’s response was that, since compliance in torture is a criminal
felony,
PHR-I and PCATI should report the case to the police; however, the IMA has

so far refused PHR-I's and PCATI's invitation to join them in making such
a
complaint. The Ministry of Health has stated that it is investigating the
case,
but no outcome has yet been reported,

The Declaration of Tokyo of the World Medical Association (WMA)
prohibits
doctors from condoning or participating in torture, and requires them to
speak out when they encounter it. Failure to do so is defined as
complicity in
torture. The IMA has repeatedly and publicly stated its commitment to the
Declaration of Tokyo, and has included reference to it in a booklet on
medical
ethics, distributed to its 22,000 members. The failure of IMA to ensure
that
these rules are reflected in its practice speaks for itself. These
failures by one
of its member Associations has made it clear that the WMA must issue some
form of definitive and binding directives

The WMA is aware of the allegations in the ‘Ticking Bombs’ report,
and of the
more recent case described above. Furthermore it is aware of the complex
situation which exists for doctors working in the Israeli Prison System
(IPS).
The fact that these doctors are employed under the direction of the
Ministry
of Internal Security clearly impairs their professional independence. If
one
wishes them to object to and report torture, their professional
independence
must be secured, their awareness of their ethical obligations raised,
legal
protection as `whistle blowers' assured, and a secure address provided to
which their testimonies can be submitted. As we have witnessed in other
places in the world, it is unlikely that anything will change without
steps of
this kind,.

We suggest that the WMA now needs to consider concrete
recommendations
for physicians, and for National Medical Associations whose members may be

faced with situations where they encounter evidence of torture. The WMA
must organize a thoroughgoing discussion of the issue, and, based on its
case studies, make clear its expectations of its member Medical
Associations.
National Medical Associations have failed repeatedly to speak out against
torture. The way in which the cases in Israel have been handled shows
that it
is high time for the WMA to make clear what it expects from national
Medical
Associations, what conduct is clearly insufficient, and what conduct
violates
medical ethics. Should it be necessary to strengthen the WMA’s hand in
such
an exercise, the March 2009 Resolution of the UN Human Rights Council
provides both the authority of a UN Resolution and the resources of the UN